Authors

• Vlatka Rešković — Croatia
• Lukšić — Croatia — ORCID: 0000-0002-4721-3236
• Jadranka Šeparović — Croatia
• Hanževački — Croatia — ORCID: 0000-0002-3437-6407

DOI

Full Text

For several years, Croatia has been recognized as an equal member of the European Association of Cardiovascular Imaging (EACVI). This was confirmed by numerous activities of our Working Group at the national and European level over the past year. As in Europe, we have also recognized the importance of comprehensive, complex, and multi-modality imaging due to the increasingly demanding needs of complex heart pathology we are faced with today. In parallel with the development of technology, a more and more complex approach to the analysis of heart morphology and hemodynamics is being developed, providing unprecedented possibilities for imaging and hemodynamic calculations. However, these procedures require the engagement of highly educated specialist/subspecialists for the analysis of archived images and data, which can last from a minimum of 30 minutes to as much as several hours. Advancements in echocardiography over the last few years have been accompanied with the development of several new methods that are already being implemented in our daily clinical practice. This includes deformation analysis using the 2D speckle tracking method or tissue Doppler imaging, which can provide valuable information on myocardial function in, for instance, coronary heart disease (CHD), following the effects of cardiotoxic therapy, cardiomyopathies, myocarditis, etc. Tissue Doppler imaging is also used for dyssynchrony study , which allows very successful selection of appropriate candidates for the implantation of resynchronization devices and monitoring of myocardial function recovery due to resynchronization therapy. Furthermore, stress echocardiography is a method that has seen increasingly common use in recent years and is used not only in CHD for the assessment of inducible ischemia and viability, but increasingly also in valvular heart disease, as well as in some cardiomyopathies. When dealing with valvular heart disease, especially complex or multiple valve disease, the conventional methods include color Doppler imaging, hemodynamic measurements, and 2D imaging, but over the last few years these examinations have become inconceivable without the use of 3D transthoracic (TTE) and transesophageal echocardiography (TEE). For instance, the assessment of mitral regurgitation begins with a TTE with hemodynamic measurements, determination of etiology and severity quantification using volumetric quantitative and semi-quantitative methods. This is followed by transesophageal echocardiography (TEE) with 3D or 4D TEE. The data is analyzed later, not only by 3D image reconstruction for visualization of valve morphology, but also by preforming very specific measurements of annulus size, coaptation height and coaptation areas, tenting angle, etc., in order to decide on further optimal treatment options. This is because different etiologies of valvular diseases indicate different decisions on when and how the intervention should be performed. Exercise stress can also help in this process by, for instance, recognizing progression of valve regurgitation or development of pulmonary hypertension in exertion, or, in case of valvular stenosis, for measurement of gradient increase, valvular area change and assessment of contractile reserve during exercise. When cardiac surgery is expected, a good echosonographer should be able to provide the surgeon with exact measurements of regurgitant volumes, stenotic areas, annulus sizes and areas; to precisely analyze valve morphology and define concomitant valve diseases, as well as to follow up, by the means of echocardiography, the patient’s whole intraoperative and postoperative period. With the development of new percutaneous methods of valve reparation and replacement that are already used worldwide, more and more is to be expected from us. Thus, to achieve quality standards of practicing this new methods and their implementation in daily clinical practice, continuous education and the acquisition of new knowledge and skills is required; it is also necessary to ensure there is enough time to perform these complex examinations. Consequently, new diagnostic-therapeutic procedures (DPT) have been introduced. However, for a laboratory to be capable of performing complex examinations, the personnel employed must be accredited and the procedures standardized. This ensures a coherent, consistent, and high-quality approach to echocardiography throughout our country. In line with the recommendations of the European Association of Cardiovascular Imaging (EAVCI) ( 1 ), the Working Group on Echocardiography and Cardiac Imaging Modalities of the Croatian Cardiac Society advocates the standardization of echocardiographic examinations as the first step towards consistent and comparable quality in echocardiographic data and their applicability, which is ultimately for the benefit and safety of the patients ( 2 , 3 ). The second step is accreditation. The National Accreditation exam was held last year, with several candidates completing the written part of the examination and one completing the whole accreditation procedure. The accreditation of Working Group members is important in order to apply for national and European accreditation of echocardiographic laboratories, which will in turn allow us to participate in many European projects and registries. One of these is EuroEndo, the European registry for endocarditis, which is just starting to include the first patients with the participation of six Croatian centers. The results of the EACVI study “Cardiovascular imaging practice in Europe” ( 4 ) were published in May 2015; 41 European countries participated in the study, including Croatia. The goal was to establish the current state of particular imaging methods in Europe. The results showed that we are among the leading European countries in this area: our National Accreditation program has been regularly held already since 2011, and such programs exist in only a fifth of the examined countries. However, examination costs in Croatia are still lower than in Europe (e.g. transesophageal ultrasound and stress echocardiography are priced at over 200 EUR in a fifth of the examined countries). Waiting lists are long in other countries as well, and in Croatia the list is based on medical indications. Regarding the activity of the Working Group in Croatia, the most significant event was certainly the CroEcho 2015 congress that was held in Opatija from the 28 th to the 30 th of May, 2015. More than 360 Croatian and foreign participants, lecturers, and presenters attended the congress, which confirms its status as the larges echocardiographic gathering in the region. A large part of the congress program was dedicated to educational content from echocardiography as part of the Teaching Course that included interactive imagining workshops with examples from clinical practice. Participants could also attend workshops in advanced echocardiography on the topics of 2D myocardial deformation analysis, 3D echocardiography, and mechanical dyssynchrony assessment. The quality of the congress was recognized by the European Board of Accreditation in Cardiology (EBAC), and the quality of the Teaching Course by the Education Board of EAVCI. In addition to CroEcho, the ESC pocket guidelines for the treatment of valvular heart disease were translated with the cooperation of the Working Group for Valvular Heart Disease. The translations of EACVI recommendations are also in progress. Education is still the focus of the activities of the Working Group, and field workshops have regularly been held across the country for the past several years as part of the “Echo on wheels” project. We can announce that 4 workshops will be held this year (information on the topics, locations, and schedules of the workshops can be found on the webpage http://croecho.kardio.hr/ ), and the next CroEcho 2017 will be held from May 4 to May 6, 2017.